Modification of the Merendino procedure.
The jejunal interposition operation after resection of distal esophagus and cardia, designed by Merendino and Dilard, has not been widely employed until now. The complexity of the procedure, demanding high performance, and still unacceptable postoperative mortality, were limiting factors and a challenge for many surgeons. The aim of this paper is to present three modifications of the original technique, without changing the basic concept of the Merendino procedure. These modifications differ from the original technique in three main ways: the longer isoperistaltic jejunal segment, the terminolateral mechanical esophagojejuno anastomosis, and the placement of the lower jejunogastric anastomosis on the posterior wall of the stomach. This report comprises an experience in 29 patients operated on in period 1972 through 1995. There were two postoperative deaths and long-term results were excellent in all except one patient who had an ischemic stenosis of the transplanted jejunal segment. Despite this, the Merendino procedure, simplified by these modifications, deserves to be more frequently used in the treatment of undilatable or recurrent strictures and other benign lesions which require resection of the distal esophagus and cardia.
Gerzic
Z B
ZB
Department of Esophagogastric Surgery, Institute of Digestive Diseases, Belgrade, Serbia.
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D002299:Cardia / Q000601:surgery; D002423:Cause of Death; D004940:Esophageal Stenosis / Q000209:etiology / Q000601:surgery*; D016629:Esophagectomy; D004942:Esophagitis, Peptic / Q000150:complications; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D007511:Ischemia / Q000209:etiology; D007583:Jejunum / Q000033:anatomy & histology / Q000098:blood supply / Q000637:transplantation*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010528:Peristalsis; D011183:Postoperative Complications; D012008:Recurrence; D013270:Stomach / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome